RFA for PTSD Pharmacotherapy: Calling Clinical MDMA?

NIMH has issued an RFA on Clinical Pharmacotherapy for PTSD: Single and Collaborative Studies (R34). From the summary:

Purpose. The sponsoring agencies jointly issue this Funding Opportunity Announcement (FOA) to stimulate research grant applications focused on pharmacological treatments for Post-Traumatic Stress Disorder (PTSD). Medications along a continuum of development and testing (i.e., exploratory compounds ready for human testing, medications used in other areas of medicine and thought to be useful for a new indication (PTSD), and psychiatric medications currently used off-label to treat PTSD) are appropriate as the focus of a research grant application in response to this FOA. The sponsoring agencies seek to advance PTSD pharmacotherapy research by providing resources to better understand feasibility, tolerability, acceptance, safety, possible efficacy and risk/benefit ratios pertaining to symptoms and symptom severity, side effects, and treatment gains in functioning associated with available and novel medications. The sponsoring agencies anticipate the results of such studies will help identify potential medications suitable for larger scale efficacy, effectiveness and services research studies.


Pharmacotherapy eh? Sounds like an opportunity for the clinical MDMA people does it not?
Back to the RFA, some additional rationale for the importance of this study, (since we're debating RFA-driven science and all):

Data from the U.S. Department of Veterans Affairs (VA) reveals that more than 240,000 veterans of the Iraq and Afghanistan conflicts have become eligible for VA benefits and that 20 percent of these new veterans have received health care at a VA facility since returning home. Possible mental disorders have been reported in 26 percent and the most common diagnoses were adjustment disorders, among them PTSD. Thus, effective PTSD treatment is a priority for the VA healthcare system for the newest generation of veterans as well as those with chronic cases of PTSD from prior deployments such as Vietnam.

Yeah, no duh!
So where are we now?

With regard to pharmacotherapy, the U.S. Food and Drug Administration (FDA) has approved two medications for treating PTSD in adults; sertraline and paroxetine, both selective serotonin reuptake inhibitors. While data support the use of these medications, not everyone treated pharmacologically improves. Moreover, there appears to be poor correspondence between the PTSD treatment evidence-base and practices of clinicians. Data from limited but important surveys of treating clinicians reveals that physicians' preferred treatment of symptomatic persons is pharmacological treatment.

Well, if we had good solutions, they wouldn't be calling for more studies, would they?
Scientists: Among other duties, cleaning up after bad public policy decisions.

6 responses so far

  • alpha1-AR lover says:

    PSA: Besides sertraline and paroxetine there has been some development in other pharmacotherapies. In a serendipitous discovery that has been now examined in several clinical trials the alpha1-adrenergic receptor (alpha1-AR) antagonist prazosin has been shown to be an effective therapy against night and day terrors in combat and non-combat PTSD. Prazosin is a relatively safe drug that has been used for decades to treat BPH (an enlarging prostate) and is very inexpensive. In addition, just a few days ago Murry Raskind and colleagues published a small clinical trial demonstrating the efficacy of prazosin to combat alcohol use disorders (published in ACER).
    disclaimer: I'm not anyone on these studies
    Raskind's first case report study, several larger clinical trials havehave followed:
    http://www.ncbi.nlm.nih.gov/pubmed/10732660?ordinalpos=65&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

  • leigh says:

    further complicating the issue: brain injury. i'd venture to say this confound is more likely in a patient who has just come home from a war than someone who witnessed a horrific event. i'm glad to see more research dollars going this way.

  • Dr Feelgood says:

    Hey DrugMonkey,
    Are you attending the Society for Nerdoscience meeting in DC? If so, you should really arrange a blog based boozefest for the wayward neuroscientists enthusiasts of your little community here.
    Dr F (an NIH funded MDMA researcher, huzzah!)

  • legend says:

    I am a disabled vet with degenerative disc disease in N.C.
    I read here in absolute horror that the VA wants to study the best treatments for PTSD, especially after they labelled 20,000 or so Vets returning with PTSD as "Behavioral Problem" vets, with personality disorders. Here is what is really going on:
    they are attempting to hold down treatment costs, just like what they are pulling off at VA clinics treating pain related vets. I have been taking Oxycodone, uneventfully, for years. Suddenly, they sign onto the idea that I needed my meds monitored, and required me to sign a Pain Management agreement....and submit voluntarily to piss tests, for my safety.
    I refused, and once I refused, they then retaliated by schedulling me a hearing for my continued level of disability. They sent me to a clinic that did not even have an x-ray machine, and VOILA! 50 percent became 20 percent, and I was damn near a new man in their files.
    I then filed another OIG complaint, but this time I spent my money, got a cat scan, and their attempt at controverting (stealing)my percentage of disability rating for speaking out was stopped by ACTUAL MEDICAL EVIDENCE. But I had to provide it FOR THEM. Now, my new appointment has been rescheduled four times since March of this year, and they still refuse to give me meds for pain without me signing a form which was clearly written for drug offenders on probation, as the form had "Vice" as part of it's document label.
    So they just wanted to keep me and other vets away from expensive pain meds by catching us in some bogus urine test mash-up, and that's their way to keep down costs, by NOT PROVIDING DRUGS!
    If they are allowed to prescribe THEIR REGEMINE OF DRUGS for your PTSD, THEN KNOW THIS: you will be placed in a database for the feds to examine your drug use patterns, you will be kicked out of pain management if they even suspect you are using even one more pain pill or PTSD pill per day than the doctor prescribes, and if you complain, stand by to potentially lose your disability rating to their preselected hack punked underequipped diagnosis.
    So good luck with them Micromanaging this issue, because if thy really cared about us, they would consider the some 15,000 who die from NSAID Advil and Ibuprofen liver failure, while only less than 50 are affected every year who take Opiods that actually treat pain safely in correct dosages.

  • kael says:

    leigh: people who witness horrific non-combat events are often mired in domestic violence. lotta risk for brain injury in most PTSD patients, I'd assume.

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